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General NPI Number Information
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NPI Number | 1215328273
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTISTRY, INC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 435 HIGHLAND AVE SUITE 210
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City | CHESHIRE
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State | CT
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Zip | 06410-2572
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Country | US
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Telephone | 203-272-7271
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Fax | 203-272-8882
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Provider Business Mailing Address
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Address Line | 435 HIGHLAND AVE SUITE 210
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City | CHESHIRE
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State | CT
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Zip | 06410-2572
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Country | US
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Telephone | 203-272-7271
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Fax | 203-272-8882
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. INNA MASCO
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Credential |
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Telephone | 203-272-7271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8852
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License Number State | CT
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